Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Change of Enrollment Information	Modified	17100	8550	0	Form and Instruction	CMS-855(S)
					Form and Instruction	CMS-855S
					Form and Instruction	CMS-855-S
Initial Enrollment	Modified	8750	35000	0	Form and Instruction	CMS-855S
Initial Enrollment	Modified	8750	35000	0	Form and Instruction	CMS-855-S
Revalidation of enrollment information	Modified	17500	70000	0	Form and Instruction	CMS-855S
Revalidation of enrollment information	Modified	17500	70000	0	Form and Instruction	CMS-855-S
Surety Bond Compliance	Removed	0	0	0	Form and Instruction	CMS-855(S)
Total burden requested under this ICR:		43350	113550	0
To view an IC, click on IC Title